Geriatric assessment predicts survival for older adults receiving induction chemotherapy for acute myelogenous leukemia

Klepin, Heidi D.; Geiger, Ann M.; Tooze, Janet A.; Kritchevsky, Stephen B.; Williamson, Jeff D.; Pardee, Timothy S.; Ellis, Leslie R.; Powell, Bayard L.

doi:10.1182/blood-2012-12-471680

Cited by 361 publications

(290 citation statements)

References 68 publications

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“…This result is concordant with other studies that have demonstrated that older cancer patients with cognitive impairment have a higher risk of death compared to those with normal cognitive function (28)(29)(30). These results can be easily explained.…”

Section: Discussionsupporting

confidence: 92%

Identification of clinical parameters predictive of one-year survival using two geriatric tools in clinically fit older patients with hematological malignancies: Major impact of cognition

Dubruille

Libert

Roos

et al. 2015

Journal of Geriatric Oncology

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Little is known about the reliability of G8 screening tool and the prognostic value of clinical parameters within the Comprehensive Geriatric Assessment (CGA) in clinically fit older patients with haematological malignancies. This study was performed to assess the reliability of G8 as a screening tool and to determine the predictive value of CGA items in terms of one-year overall survival (OS). G8 and CGA were proposed to 107 consecutive patients (65-89yrs) with haematological malignancies that were judged clinically fit to receive chemotherapy. Ninety patients were evaluable with both scales; 72% and 80% were defined as "vulnerable" when evaluated with G8 (≤14.5) or CGA (≥2 impairments) respectively. The area under ROC-curve of G8 compared to CGA was 0.749 ± 0.051. Neither G8 nor CGA total score were predictive of one-year OS. However, age (HR=1.09, 95%CI: 1.009-1.185; p=0.029), diagnosis (HR=5.99, 95%CI: 2.322-15.428; p<0.001) and cognitive status (HR=3.50, 95%CI: 1.132-10.849; p=0.030) were predictive of OS. We conclude that in our selected haematological patients 1) the G8 score does not help selecting patients for CGA 2) the G8 and CGA total score do not predict OS 3) in addition to the age and disease itself, cognitive impairment appears to be a powerful prognostic factor.

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Section: Discussionsupporting

confidence: 92%

Identification of clinical parameters predictive of one-year survival using two geriatric tools in clinically fit older patients with hematological malignancies: Major impact of cognition

Dubruille

Libert

Roos

et al. 2015

Journal of Geriatric Oncology

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“…Although assessment of risk of treatment-related mortality (TRM) after intensive therapy is usually most relevant in older patients (commonly above the age of 65 years), age is merely one, and not the most important, predictor of TRM. [130][131][132][133][134][135] Furthermore, TRM rates are declining due to improved supportive care and to better health status in older patients. 136,137 Therefore, age alone should not be the decisive determinant to guide therapy.…”

Section: Current Therapymentioning

confidence: 99%

“…Several risk scoring systems are available that use patient-specific and diseasespecific factors to make the choice of intensive or alternative treatment. 74,132,133,210 The relevance of systems 193,194 originally designed to forecast NRM after allogeneic HCT is under investigation. 211 Treatment alternatives for unfit patients are limited to best supportive care, low-intensity treatment, or clinical trials with investigational drugs.…”

Section: -209mentioning

confidence: 99%

Diagnosis and management of AML in adults: 2017 ELN recommendations from an international expert panel

Döhner

Estey

Grimwade

et al. 2017

Blood

4,790

5,387

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The first edition of the European LeukemiaNet (ELN) recommendations for diagnosis and management of acute myeloid leukemia (AML) in adults, published in 2010, has found broad acceptance by physicians and investigators caring for patients with AML. Recent advances, for example, in the discovery of the genomic landscape of the disease, in the development of assays for genetic testing and for detecting minimal residual disease (MRD), as well as in the development of novel antileukemic agents, prompted an international panel to provide updated evidence- and expert opinion-based recommendations. The recommendations include a revised version of the ELN genetic categories, a proposal for a response category based on MRD status, and criteria for progressive disease

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“…35 These impairment were independently associated with worse outcomes in patients with cancer. [38][39][40][41][42] Second, geriatric assessment can predict survival and adverse events of treatment to assist clinical decision making. Treatment decisions in older patients with cancer can be challenging, as other comorbid conditions may limit life expectancy and the ability to tolerate oncologic treatment.…”

Section: Why Perform a Geriatric Assessment?mentioning

confidence: 99%

What Every Oncologist Should Know About Geriatric Assessment for Older Patients With Cancer: Young International Society of Geriatric Oncology Position Paper

Loh

Soto‐Pérez‐de‐Celis

Hsu

et al. 2018

JOP

137

105

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Aging is a heterogeneous process. Most newly diagnosed cancers occur in older adults, and it is important to understand a patient's underlying health status when making treatment decisions. A geriatric assessment provides a detailed evaluation of medical, psychosocial, and functional problems in older patients with cancer. Specifically, it can identify areas of vulnerability, predict survival and toxicity, assist in clinical treatment decisions, and guide interventions in routine oncology practice; however, the uptake is hampered by limitations in both time and resources, as well as by a lack of expert interpretation. In this review, we describe the utility of geriatric assessment by using an illustrative case and provide a practical approach to geriatric assessment in oncology. CASE J.K. is a 73-year-old man who presented to his primary care physician complaining of bright red blood per rectum. He has a medical history of coronary artery disease, hypertension, hyperlipidemia, and cerebrovascular disease. He is on aspirin, lisinopril, metoprolol, and atorvastatin. A subsequent colonoscopy revealed a 3-cm mass in his descending colon. Biopsy of the mass showed invasive adenocarcinoma. He underwent computed tomography scans of the chest, abdomen, and pelvis, which showed no evidence of metastases. A laparoscopic colectomy was performed, and his cancer was staged as T2N2 (stage III) and microsatellite stable. He is referred to you to discuss adjuvant chemotherapy.

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Geriatric assessment predicts survival for older adults receiving induction chemotherapy for acute myelogenous leukemia

Abstract: Key Points Geriatric assessment, with a focus on cognitive and physical function, improves prediction of survival among older adults treated for AML. Use of geriatric assessment may inform trial design and interventions to improve outcomes for older adults with AML.

Cited by 361 publications

References 68 publications

Identification of clinical parameters predictive of one-year survival using two geriatric tools in clinically fit older patients with hematological malignancies: Major impact of cognition

Identification of clinical parameters predictive of one-year survival using two geriatric tools in clinically fit older patients with hematological malignancies: Major impact of cognition

Diagnosis and management of AML in adults: 2017 ELN recommendations from an international expert panel

What Every Oncologist Should Know About Geriatric Assessment for Older Patients With Cancer: Young International Society of Geriatric Oncology Position Paper

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